Impact story: Global voices
in psychiatry's most influential manual
The context
The Diagnostic and Statistical Manual of Mental Disorders (commonly: DSM) is the most widely used diagnostic tool in mental health, published by the American Psychiatric Association (APA). It is used extensively by psychiatrists in every region, it is available in more than 18 languages, and it reaches well beyond the consultation room into research priorities, insurance, entitlements, training and law. Successive editions over more than 70 years have been written by authors from a small number of countries and a narrow set of professional backgrounds, and the manual has then travelled everywhere.
In 2024, the APA created a “Future DSM” Strategic Committee to produce a road map for the next iteration, with subcommittees alongside it, including one on the social circumstances that shape mental health. The road map was published in January 2026.
Seeing the importance of this opportunity, at GMHAN we immediately gathered what our members, partners and advocates with lived experience across our regions had to say about the Manual, and we took it directly to the people writing the road map. Our Secretariat Lead presented twice to the APA’s subcommittees.
Our Impact
What we said
GMHAN has already highlighted that:
The DSM places its emphasis on the individual, sidelining community, generational family patterns, history of trauma and the systems people live inside.
Social determinants belong in diagnosis and in treatment decisions, rather than in a background section.
A diagnosis follows a person through life without changing as they change, and the frameworks of duration, cycles and treatment plans need re-evaluating.
Symptoms should be understood through how they affect a person's life, and through what a person can do, rather than only through deficits.
The manual should serve as a guide rather than dictate terms.
People who are diagnosed need an accessible version written for them, and clinicians need training in the social determinants that is deep and relevant to practice.
What has changed
We are pleased to see several of these points in the strategy papers:
Contextual factors, including socioeconomic, cultural and environmental determinants of health, are proposed as the first domain of a diagnostic formulation, and one of the strategic direction published papers by the APA is given over entirely to determinants and intersectionality.
Functioning and quality of life are proposed as essential elements of a complete diagnosis rather than as supplementary measures.
The manual is proposed to become a living document, revised continuously, which speaks directly to a diagnosis that never moves as a person moves.
The Committee has set out that the DSM should be applied with epistemic humility, accepting that its categories are working constructs.
The scale of impact
A revision on this scale happens roughly once in a generation, and the structure being settled now will hold for decades, wherever clinical decisions are made about who gets what care. This is incremental progress on a document that has direct influence on the care, lives, stigma and attitudes towards people living with mental health conditions. We will continue to do the work of influencing the revisions of the Manual over the next several years, which makes this the moment to keep pushing. GMHAN is uniquely positioned to bring together evidence, lived experience voices, and diverse global perspectives at this point in the process, convening dialogue across disciplines, regions and communities.